White Fillings - Back Teeth

Dr. Chalifoux is a national expert on white fillings on back teeth referred to as posterior composites by dentists. "Aesthetic Guidelines for Posterior composite Restorations," by Paul R Chalifoux, DDS The Aesthetic Chronicle 1996 is highly referenced by the Academy of General Dentistry and their dentists.

A composite resin is a tooth-colored plastic mixture filled with glass. In the past, dental composites were confined to the front teeth because they were not strong enough to withstand the pressure and wear generated by the back teeth.

Following preparation, the dentist places the composite in layers, using a light specialized to harden each layer. When the process is finished, the dentist will shape the composite to fit the tooth. The dentist then polishes the composite to prevent staining and early wear. It takes the dentist about 10-20 minutes longer to place a composite than a silver filling. Placement time depends on the size and location of the cavity and the larger the size, the longer it will take.

The average cost of posterior composites is about one-and-a-half to two times the price of a silver filling. Most dental insurance plans cover the cost of the composite up to the price of a silver filling, with the patient paying the difference. As composites continue to improve, insurance companies are more likely to increase their coverage of composites.

These restorations replacing mercury based silver amalgam fillings are used for national advertising by the Kerr Corporation and were published in an article entitled "Comprehensive Composites" in Dentistry Today

Esthetics are one of the main advantages, since dentists can blend shades to create a color nearly identical to that of the actual tooth. Composites bond to the tooth to support the remaining tooth structure, which helps to prevent breakage, minimize leakage and insulate the tooth from excessive temperature changes.

After receiving a composite, a patient may experience post-operative sensitivity. Also, the shade of the composite can change slightly if the patient drinks tea, coffee or other staining foods. Composites tend to wear out sooner than silver fillings in larger cavities, although they hold up as well in small cavities. Studies have shown that composites last 7-10 years, which is comparable to silver fillings except in very large restorations, where silver fillings last longer than composites.

In the past, teeth were most commonly repaired with amalgam (silver) fillings or gold restorations. Thanks to advances in modern dental materials and techniques, teeth can be restored with a more aesthetic and natural appearance. There are different types of cosmetic fillings currently available. The type used will depend on the location of the tooth and the amount of tooth structure that needs to be repaired.

The other type of “white fillings” are called Composite or Porcelain Inlays and Onlays. These fillings are usually placed in back teeth when esthetics is of utmost concern. In order to increase their strength and longevity, they are fabricated in the laboratory and then bonded into position in the office. This is a two visit procedure rather than the one visit required to place a direct composite filling. However, when it comes to strength and cosmetics, the extra time and expense is well worth it! I hope that you now understand a little bit more about white fillings.

Below is a list of all the factors a dentist should consider when restoring with dental composites.

FIGURE 1

Comprehensive Composite Restoration

I. TREATMENT PLANNING

1. Smile Design Restorative Situations

A. Smile Shape Class 1

Arch size, position and shape Class 2

Arch to arch relationship Class 3

Gingival position, shape, and contours Class 4

Overall incisal edge position and shape Class5

Tooth to face proportion, shape, and position Surface Defects

Midline placement, tilt, and arch to arch relationship Peg Laterals

Perspective Diastema

Symmetry Papillae loss

B. Tooth Shape Veneers

Silhouette Form Inlays

Gingival contour Onlays

Incisal edge Crowns

Embrasure form Splinting

Contact placement and size Rotations/tipping

Face Form Congenital Defects

Line angle placement and shape Porcelain Repair

Gingival height of contour Composite Repair

Incisal shape Tooth Replacement

Long Axis Implant Access

Meisal/Distal, Labial/Lingual Periodontal Splinting

Surface Contours

Flat, concave, and convex

Surface Texture Smile Imperfections

General uniform texture

Individual grooves and dimples Tooth Color

Tooth Color Craze lines

Tooth to tooth Decalcifications

Arch to arch Fillings

Discoloration

2. Color Stains

Dentin exposure

A. Color Examination Cavities

Observing and recognizing: Tooth Position

hue, chroma, value, fluorescence, translucency Tipping

B. Color Replication Rotation

Understanding materials to produce and match: Crowding

hue, chroma, value, fluorescence, translucency Tooth Loss

Diastema

3. Tooth Color Intrusion

Extrusion

A. Normal Arch shape

Incisal and interproximal translucency Tooth Structure

Body shade Chips

Gingival transition Cracks

Local color: stains, grooves, etc Abrasion

B. Abnormal Attrition

Aging, stains, developmental, wear, etc Wear

Surface Defects

4. Tooth Shape Surface Texture

Gingival Contours

A. General shape: square, oval, etc Cavities

Face: Incisal edge, line angles, and gingival contour Developmental

Silhouette: embrasure, incisal edge, gingiva, contacts

B. Surface contours and texture

General contours, dimples, grooves, convexities, concavities

5. Tooth Position

Tipping, rotation, super eruption, under eruption within arch

Arch to arch

6. Esthetic Goals

A. Limitations to Ideals

General appearance, emotional, environmental

B. Limitations to Treatment

Physical, financial, psychological

II. COMPOSITE RESTORATION

7. Tooth Preparation

Preparation design

Bur/instrument selection

Surface bonding and mechanical retention/resistance preparation

Enamel finishing

8. Bonding Techniques

Techniques for enamel, dentin, other dental material bonding

9. Material Selection

A. Restoration Color

Material

Hue, chroma, value, translucency, florescence

Tints and opaque

B. Defect Analysis

Tooth Backing

Color of defect

Hue, chroma, value, translucency

Defect size

Defect shape

No Tooth Backing

Defect size

Defect shape

C. Restoration Strength

Force Analysis

Direction

Lateral, compressive, shear, rotational

Magnitude

Frequency

Occlusion

Para functional habits

Grinding, biting nails, etc

Resistance to Force

Physical Characteristics

Shear, tensile, compressive, modulus of elasticity, etc

Material thickness

Material resistance to cracks and crack propagation

Technique complexity

Support Strength

Preparation design

Bond strength

Surface area

Material composition/quality of tooth structure/techniques

Tooth strength

Cross section

Type and quality of structure

D. Wear

Strength and frequency of abrasive, adhesive, chemical, corrosive and fatigue wear

Placement and pre cure shaping characteristics

E. Ease of placement

F. Ease of precure shaping

G. Ease of post cure shaping

H Surface polish characteristics

I. Stability of polish

J. Color stability

10. Material Placement Techniques

Isolation

Matrix techniques

Color replication

Strength

Health

11. Composite Shaping

Technique

Instrumentation Selection

12. Composite Finishing

Techniques

Instrumentation

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Paul R. Chalifoux, DDS

277 Linden Street Suite 209

Wellesley, MA 02482

781-235-1747

chalifoux@comcast.net